BJC HealthCare and School of Medicine to their and [unreadable] Washington University propose US (=. Resources expertise in Medical Informatics, Infection Control, Healthcare outcomes and Economics to measure economic cost of antimicrobial resistance in a hospital setting. We have assembled a multidisciplinary team of clinicians, epidemiologists, economists, biostatisticians, and scientists study antimicrobial-resistant bloodstream infections and their economic impact. The first aim of this proposal is to determine the impact of antibiotic-resistant bloodstream in a surgical intensive care unit and medical intensive care unit at Barnes- Jewish Hospital (BJH), a 1200-bed tertiary care facility using a four-year cohort of approximately 2080 _atients from 1999-7/2004. We will determine the incidence and prevalence of antimicrobial resistant _loodstream infections, including methicillin resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and antibiotic-resistant gram-negative bacteria. We will examine risk factors, outcomes, and the economic cost associated with antimicrobial-resistant and sensitive bloodstream infections using our informatics database and hospital cost accounting databases. Multivariate analysis controlling for severity of illness will be performed. In addition, we will assess the validity of two different data collection methods for assessing patient comorbidities; prospective medical record review and use of billing data and ICD-9 codes. The second aim of this proposal is to determine the impact of MRSA, VRE and antibiotic-resistant gramnegative bacterial bloodstream infections in a hospital-wide cohort of patients at BJH over 2 years (2002-2003). We will determine incidence and prevalence of antimicrobial-resistant bloodstream infections and examine the risk factors, outcomes, and cost associated with these infections in more diverse group of patients throughout the hospital. This research can then be applied to other settings to accurately estimate [unreadable] [unreadable] [unreadable]